Male Reproductive

Question 1

Structures of the male genitalia

Answer 1

Penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles

Question 2

Cremasteric muscles

Answer 2

Allows scrotum to relax or contract

Question 3

Spermatogenesis requires a temperature of

Answer 3

37 degrees celsius

Controlled by altering distance of testes from body

Question 4

Testicles

Answer 4

Produce spermatazoa and testosterone

Question 5

Epididymis

Answer 5

Storage, maturation and transit of sperm

Question 6

Prostate Gland

Answer 6

Produces major volume of ejaculatory fluid

Fibrinolysin liquefies coagulated semen for optimal sperm motility

Question 7

Erection of penis

Answer 7

Two corpora cavernosa engorge with blood (20-50mL)
Arterial dilation and decreased venous outflow produce increased blood supply
Controlled by ANS and local synthesis of nitric oxide

Question 8

Ejaculation involves

Answer 8

Vas deferens, epididymides, prostate and seminal vesicles

Orgasm is followed by constriction of blood vessels

Question 9

Infants and Children

Answer 9

Sexual differentiation occurs at 12 weeks of gestation

Third trimester - testes descend

Question 10

Adolescents

Answer 10

Onset of puberty - scrotal skin reddens, thins and becomes pendulous, hair appears on penis
Prostate gland enlarges

Question 11

Older Adults

Answer 11

Pubic alopecia 
Scrotum more pendulous 
frequency of SA declines 
Erection develops more slowly 
Orgasm less intense

Question 12

Genital Hair Distribution

Answer 12

Coarser then scalp hair

Question 13

Inspection of Penis

Answer 13

Dorsal vein should be apparent
Circumscised or uncircumcised
Look for smegma if uncircumcised
Phimosis - foreskin is tight and cannot be retracted, result of balanitis (glans inflammation)
Circumcised pts will have glans exposed and erythematous and dry

Question 14

Balanoposthitis

Answer 14

Inflammation of glans penis and prepuce occur in uncirumcised individuals either bacterial or fungal
More common in those c DM

Question 15

Urethral Meatus

Answer 15

Orifice should appear slitlike and be located on the ventral surface
Opening should be glistening and pink
Erythema or discharge indicates inflammatory disease

Question 16

Penile Shaft

Answer 16

Palpate for tenderness and induration
Presence of dischage may be STI
Should be free of nodules
Priapism - prolonged erection; can occur in those with leukemia, hemoglobinopathies (Sickle Cell) or as a result from medications for impotence

Question 17

Scrotum

Answer 17

Reddened skin may be inflammatory process
Left testicle is usually larger due to longer spermatic cord
Thickness varies c temperature and age
Lumps = sebaceous cyst
Unusual thickening can be edema - does not imply genitalia problem, but cardiac or hepatic

Question 18

Hernia

Answer 18

Pt stands and bears down
Inspect inguinal and fossa ovalis
Auscultate for BS is uncomplicated reducible hernia
Ask pt to cough, inguinal hernias will produce viscus against finger
Indirect hernias lie within the inguinal canal
Hernias can also come through external canal and even pass into the scrotum
Indirect hernias suggest bilateral herniation
If viscus is felt medial to external canal, usually represents direct inguinal hernia

Question 19

Testes

Answer 19

Should be sensitive but not tender
Smooth, rubbery and free of nodules
Syphillis and DM neuropathy causes insensitivity to painful stimuli
Irregularities in texture indicate cyst, infection or tumor

Question 20

Epididymis

Answer 20

Smooth, discrete, larger cephalad and nontender

Question 21

Vas Deferens

Answer 21

Smooth and discrete
Should not be beaded or lumpy
Might indicate DM or TB

Question 22

Cremasteric Reflex

Answer 22

Stoke inner thigh c blunt instrument and watch for rise of testicle and scrotum

Question 23

Inspection of Infants

Answer 23

Inspect for size, placement of urethral meatus and anomalies
Length is 2-3cm
Transitory erection is common
Straight projection
Micropahllus - could be Klinefelter syndrome and may not be appropriate for circumcision
Hooked, downward bowing of penis suggests chordee
Differentiate microphallus from clitoris

Question 24

Inspection and palpation of infants

Answer 24

Do not pull back foreskin too much if infant will not be circumscribed
Inspect for ulcerations, bleeding, an inflammation
Reduced force or caliber of urinary stream may indicate stenosis of urethral meatus
Inspect scrotum for size, shape, symmetry, rugae and presence of testicles
Premature infant will be lacking regaue and testes
Edema is common
Proximal end is larger
A deep cleft in scotum is associated c amibguous genitalia

Question 25

Palpate testis of infants

Answer 25

Retractile testis have a risk of becoming an ascending or acquired undescended testis
Undescended testicle - palpable in inguinal canal but cannot be pushed into scrotum or not palpable at all

Question 26

Palpate for hernias in infants

Answer 26

Palpate over inguinal canal with fingers to feel spermatic cord
If feeling of smoothness disappears as you palpate, indicative of invisible hernia
Apparent bulge = visible hernia

Question 27

Different types of hernias in infants

Answer 27

Fluid, gas or solid material
Attempt to push the hernia back into external inguinal canal - if no change in size, most likely fluid (hydrocele)
A mass that does not transilluminate but does change in size is probably a hernia
A mass that neither changes in size or transilluminates may represent an incarcerated hernia or testicular cancer

Question 28

Inspection and Palpation in Children

Answer 28

If penis is swollen or tender or if bruises are present, suspect SA
Well-formed rugae - indicate testes have descended during infancy
Use tailor position to detect inguinal hernias
Cryptorchidism - undescended testes
Hard, enlarged, painless testicle may indicate tumor
Acute swelling of the scrotum with discoloration could be torsion or orchitis
Acute painful swelling without discoloration and a a thickened epididymis = epididymitis
Enlarged penis without enlargement of testes = precocious puberty, adrenal hyperplasia and CNS lesions

Question 29

Sexaul Maturation Rating (SMR)

Answer 29

SMRs for pubic hair and genitalia are closely correlated
Graded 1-5 (Based on changes in pubic hair, development of tests, scrotum and penis)
Correlates with physical maturity as measured by bone age compared with chronologic age